HIRASAWA, YASUSUKE

KÜSSWETTER, WOLFGANG

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Title Histological Study on The Development of PunctiformLigament Insertion Using Ligamentum Collaterale CubitiAuthor(s)KÜSSWETTER, WOLFGANG; HIRASAWA, YASUSUKECitation日本外科宝函 (1984), 53(6): 736-741Issue Date1984-11-01URL http://hdl.handle.net/2433/208815RightType Departmental Bulletin PaperTextversionpublisherKyoto UniversityArch 'Jpn Chir 53(6), 736～741, Nov., 1984 Histological Study on The Development of Punctiform Ligament Insertion U sihg Ligamentum Collaterale Cubiti WoLFGANG KusswETTER Department of Orthopaedic Surgery, University of Wiirzburg, Federal Republic of Germany (Director: Prof. Dr. A. RUTT) YASUSUKE HIRASAWA Department of Orthopaedic Surgery, Kyoto Prefectural University of Medicine (Director: Prof. Dr. K. SAKAKIDA) Recived for Publication, July 3, 1984. Summary The growth development of the humeral insertion area of the ligamentum collaterale ulnare cubiti was studied in ai.ttoptic specimens of different age groups. Dependent on the age of th、edonors, gradual changes from cartilageneous insertion to the typical 4-zone insertiOn could be obser-ved. Punctiformly inserted tendons and ligaments exhibited similar growth development in the msertion area. Introduction Joint stability is strongly dependent on the stability of its ligaments. Thus, the osseous inser-tion of joint ligaments is of clinical importance in maintaining the stability of the joint under various forms of stress acting onto the joint as traction and shearing forces. It was DoLGO-SABUROFF幻in1929, who described 4 different zones in the insertion area of the patellar tendon. His findings were confirmed by COOPER and MISOL (1970)2l histologically and by transmission electronmicroscopy of the. insertion area of th号patellartendon in. mongrel dogs. SCHNEIDER (1958)7l proved this model for punctiformly inserting tendons with .small cross-sections of the insertion area and was able to demonstrate the course ・of development. KusswETTER (1981)6> and KussWETTER and SCHMID (1975)5>.$howed the growth development of ligament insertion over an area using the example of the membrana int；巴rosseaantebrachii. Investigations of the course of growth development of punctiformly inserting joint ligaments, however, have as yet not been carried out. The observations in the area of insertion of a syndesmosis with a broad area ins巴rtionled us Key words: Punctiform ligament, Ulnar collateral ligament, Four zone formation. 索引語：点状籾帯付着，肘関節尺側々副靭帯，困層形或．Reprint requests: Yasusuke Hirasawa, Department of Orthopedic Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602, Japan. 737 to carry out corresponding examinations on the growth development of a punctiformly inserted ligament using the Iigamentum collaterale ulnare cubiti as an example. PUNCTIFORM LIGAMENT INSERTION Material and Methods For examination of the insertion area, samples were taken from the humeral insertion of the ligamentum collaterale ulnare cubiti of 23 postmortem human elbows of different donor age groups. The arm specimens were taken from the donors within a maximum postmortal interval of 48 hours. The specimens were then immediately brought into a moisture chamber with maintained environment conditions of 100% relative humidity and constant temperature of 25。Cwhere they were dissected. The soft tissues including the overlaying flexor muscles were carefully removed and the ligamentum collaterale ulnare was clearly exposed. After severance of the ligament and the removal of the synovial joint-capsula the epicondylus ulnaris together with a ligament stump was removed from the humerus with the help of a chisel. The samples were then preserved in 4箔formaldehydeand decalcified in 255ぢtitriplex-solution.After corresponding microtechnical preparation in paraffin as well as in methylacrylate serial sections of 5-6 μthickness were performed and stained. The histological investigations were then carried out by light-and polarisation micros-copy. Results The histologically examined samples were divided into five groups according to the age of the donors (Table 1). In group A, the foetal samples and those of early childhood, we were able to observe a connec-tion between the collagenous ligaments fibres and the fibre structures in the border zone of the apophyseal cartilage. Bundles of fibres penetrate to the basic substance of the cartilage like pal-isades, and then disappear more and more towards the centre. In an intermediate zone, there are round, cartilagineous cells as well as spindle-like cels, and we can recognize a increasing density of fibres form the centre to the periphery (Fig. 1) With increasing growth, the ossification in the insertion area also increases. This phenomenon can be observed in the samples of group B (Fig. 2). As growth continues, the zone of epiphyseal cartilage becomes thinner and thinner, being replaced centrally by bone formation. Table. l. Number of Specimens ??????Age of Donor ??????? ??????????????ゅ?????????ー ヮ ，??????????????』?????????? ??????????Group ???738 日外宝第53巻第6号 （昭和59年11月〉Fig. 1. Age group A, (250×） The ligament fibres structures penetrate to the cartilage of the aphophyses. Bundles of凸bresconnect with the rn atrix of the cartilage When the apophyseal layer of cartilage decreases a linking together of the collageneous fibres of the ligament and the collagenous system of bone passing through the remaining thin layer of cartilage can be observed (Group C). (Fig. 3). Fig. 2. Age group B, (lOOx) The zone of epiphyseal cartilage gradually becomes thinner. PUNCTIFORM LIGAMENT INSERTION Fig. 3. Age group C, (300×） The五brestructures of the ligament pass through the remaining thin layer of cartilage and link together with the collagenous system of bone. 739' When growth is completed-as it can be demonstrated in the samples of Group D-a calcifi-cation of the layer of cartilage next to the bone begins to form towards the centre. This shows up on the PAS staining as a deep purple strip. On the periphery, round, cartilageneous cells Fig. 4. Age group D, (120×） Calci五cationof the layer of cartilage next to the bone begins to form (blue line). The 4-zone formation of the insertion area is herewith completed. 740 日外宝第53巻第6号（昭和59年1月）in uncalcified tissue remain (Fig. 4). The formation of the insertion area is herewith completed, with a fact which was substan-tiated by al samples of Group E. Discussion SCHNEIDER (1958)7》 confirmedthe observation of HAVERS (1961)4》 thattendons which are stressed by high tractional loads penetrate the periosteum and insert directly into the bone. In this examinations of growth development of osseous tendon insertion, ScHNEIDER7> points out that, from the second to the third fetal month onward, the fibres of the tendon are slowly and progressively built into the cartilage tissue of the apophysis, as a consequence of the enlargement of the cartilageneous matrix of the bone. After the appearance of the apophyseal ossification centre, the fibres of the tendon are only gradually built into the bone as this ossification centre grows larger. According to the interpretation of BECKER and KAHL (1978)D, calcification of the zone of the cartilage is not a passive process but a ersult of the proliferative growth of the cartilagenous cels. Moreover the zone of cartilage is compared by VIDEMANN (1970)9> with an epiphyseal growth plat巴．Even after completion of skeletal growth, a zone of cartilage remains in the area of tendon inser-uon. These observations of growth development in punctiform tendon insertion areas are very similar to our r巴suitsin the insertion ar巴aof a punctiformly inserting joint ligam巴nt.Functional stress of tractional and shearing forces plays an important part as a stimulus of the transformation processes in the insertion area of ligaments and tendons. As well the ingrowth of collagenous fibres towards the bone as the formation of the 4-zone insertion with cartilageneous layers are dependent on the active forces. SENST (1974)8> who investigated osseous insertion areas of tendons could prove a direct rela-tionship between thickness of the cartilageneous layers and the amount of stress applied. That covers the observation of SCHNEIDER7> who observed that the microstructural strength of osseous tendon insertion is dependent on sex, age and profession. Functional stress is a main cause for the metaplastic changes in the osseous insertion of ligament inserting over a wider area, as we were able to show in the membrana interossea ante-brachii (K USSWETTER and SCHMIDペ1979).It also acts in the growth development of punctiform ligament insertion leading to the typical 4-zone type of logament insertion: free ligament--uncalci-fibrocartilage--calcified fibrocartilage--bone. This shock absorbing system guarantees a maximum of resistance against high traction and shearing forces. References 1) Becker W & Krahl H: Die Tendopahien. Georg Thieme Verlag, Stuttgart (West Germany), 1978, p.p. 1-112. 2) Cooper RR and Misol S: Tendon and ligament insertion. J. Bone and Joint Surg 52-A: 1-20, 1970. PUNCTIFORM LIGAMENT INSERTION 741 3) Dolgo・Saburoff B: Uber Ursprung und Insertion der Skelettmuskeln. Anat. Anz 68: 30-87, 1929. 4) Havers C: Osteologia Nova. Smith, London (England), 1691, p. 1. 5) Kiisswetter vV and Schmid K: Die Membrana interossea antebrachii das gemeinsame Gelenkband der Radioulnargelenke. Zeitschr. f. Orthop 117: 767-783, 1979. 6) Kiisswetter W: Morphologie und Biomechanik der Membrana interossea antebrachii. Georg Thieme Verlag, Stuttgart (West Germany), 1981, p. 1. 7) Schneider H: Zur Struktur der Sehnenansatzzonen: Z. Anat. Entwickl-Gesch 119: 431-456, 1956. 8) Senst W: Beitrag zur feingeweblichen Struktur der Band-Knochenverbi吋 ung. Zbl. Chir. 99: p. 275, 1974. 9) Videman T: An experimental study of the effects of growth on the relationship of tendons and ligaments to bone at the site of diaphyseal insertion. Acta orthop. scand. Suppl 131: 0 2, 1970. 和文抄録肘部側副靭帯付着部に関する組織学的研究Wiirzburg大学整形外科学教室（指導.A. RUTT教授）WOLFGANG KUSSWETTER 京都府立医科大学整形外科学教室（指導：榊田喜三郎教授）平沢泰介人体において靭帯組織は骨・関節の支持組織として いて観察した．重要な役割を果している．靭帯は巾広い付着部をもっ 胎児においては靭帯の謬原線維束は軟骨組織へと連骨間膜のようなものと，本研究で用いられた肘部尺側 続しており，加令とともに付着部の骨化が進行してい側副靭帯のように点状の付着部をもつものとの2つに た．成人においては靭帯の履原線維束は線維軟骨層，分けられる．本研究では後者の靭帯付着部の年令によ 石灰化線維軟骨層そして層状骨へと4層を形或して連る変化について追求を行った． 続していた．このような4層の形或には生後に加わる資料は8カ月の胎児より， 60才以上の23屍体の上肢 張力などの力学的要素が重要な役割を果たしている乙であり，年令により 5群に分け，肘関節尺側々副靭帯 とが推察された．の上腕骨付着部について光学顕微鏡と偏光顕微鏡を用

肘部側副靱帯付着部に関する組織学的研究

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肘部側副靱帯付着部に関する組織学的研究

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